Nursing Care For Coronary Intervention:Primary PCI: Screening How To Know Ami ? Nursing How To Do?

5/27/2011
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ก ก 3
1 Pre Intervention
2 Intervention
3 Post Intervention
Nursing Care for Coronary

Intervention:Primary PCI
Kanchana Sae-Heng
www.psuheartcenter.com
Cath-Lab Cardiac PSU Center
Pre-Intervention Screening
Screening History
How to know AMI ?
Signs & Symptom
Nursing
How to do? ECG
www.psuheartcenter.com www.psuheartcenter.com
Sign&Symtom
Typical or atypical chest pain onset
duration ,severity, relieving
factor(rest, antacid)
Shortness of breath
Nausea &vomiting
Abnormal vital signs or arrhythmia
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Heartburn or chest pain Heartburn or chest pain

Chest pain Heartburn
Sudden pressure,tightening,squeezing or Usually it occurs after eating or lying down or
crushing pain in the center of the chest that bending over
lasts more than a few minutes Sometimes stomach acid that backs up into
Pain spreading to the back,jaw,shoulders or the esophagus can leave a sour taste in your
arm especially the left arm mouth especially when you’re lying down
Chest discomfort accompained by shortness Nausea and steady ache start in upper middle
of breath,sweating ,dizziness or nausea or upper right abdomen the pain may shift to
Pressure or tightness in the chest during your shoulders,neck,arms especially after a
physical activity or under emotional stress fatty meal
ECG Guideline STEMI

Reperfusion Strategies
. . . (STEMI) ER . ก
Pharmacological reperfusion ก " Invasive strategy .)"*+,- fibrinolytic /01 /2- .)"* +,- fibrinolytic /2-
Primary PCI ก "
-Early presentation(<3 hrs from symptom onset) -Late presentation(>3 hrs)
-Invasive strategy not on option (cath lab -High risk STEMI +,-. cardiogenic
transfer PCI ก "
occupied or not available,difficult vascular access) shock killip≥ 3 transfer PCI ก
-contraindication to fibrinolytic
-Delay to invasive strategy (Door to balloon -contraindication or increase risk of - cardiogenic shock Pharmacological
reperfusion -contraindication to fibrinolytic
time>90min or PCI related time delay>60min bleeding / Intracerebral bleeding -:28;=@;A0+,- 1 st contact to
balloon time< 120 7 )" ( SK M@P N fibrin specific -cardiogenic shock
(Door to balloon -Door to needle>60min) -Door to balloon <90min fibrinolysisNP8.QRSTU-K9
-delay presentation FG1 /01 Hก7
ST_Elevation_[www.keepvid.com].mp4 STEMI 6>ก@<9M<กRSTU-K9;7
12I0 symptom onset , J K N<ก<@V;-+กE.12,;L19;7
>12 ongoing CP W>1;>-2M;<95MT DTN 678
<30min
Reperfused Non Reperfused

-ST segment 010250%5. No Reperf. Reperf.
Lead 678 ST segment 9ก
Rescue PCI
;<ก678=1> 56 789: ;,< =+
G<95. 12 ,J8KL;2 @A.=2C0<.D@E .6@F
-Resolved chest pain Rescue PCI
M0J2+กE1 N<ก<@
-Reperfusion arrhythmia
Consult Intervention Team ก HG " 8 0LA-M1 =8ก1 K7N1 O)P PCI
MICU cT <ZT N26[<PCI U@d กe<fA69F L@DMJK5W
YRST U- K9ZT N29E .9N;6[ <+;7ก<@sign Inform consent
@A.=2C0<.D@E . 6@F L19Z@2
ก HG " 80L6- M1 =8ก " Pharmacological reperfusion YClopidodogrel 4 tabs,oral + ASA 300 mg +D7 _9K
www.psuheartcenter.com www.
- RST U- K9ZT N29E .9N;6[ <+;7ก<@sign Informed consent
- Clopidogrel 4 tabs,oral + ASA 300mg +D7 _9K - 5MT SK M@P N Fibrinolytic NP8.
Cardiac Center Fax 074-451970 YShape both groin, IV accessZ-Nextension+3way(left side)
- AEW <@i< Adjunctive anticoagulant: Enoxaparine/ Fondaparinux Y-plasil 1amp / morphine IV
psuhe
Then how to do ? Initial nursing care

!8 D V/S,consciousness
- ECG - ECG Oxygen support,Monitor ECG
- ! " # $% &' - E ก: " # $% &' ' ) Defibrillator stand by
' ก ) balloon? $complication IV access
- complication - fax 789 : ; 074-451970 ! Mophine 4 mg iv then 1-2 mg q 30 min
- fax 789 : ; 1970 ! &' & cardiologist & up to 30 mg
&' & cardiologist & - IV +medication
refer L 78M
2
5/27/2011
Medication !" # ก # ก $ ! %&ER .

ASA 160-300mg chew Inform consent
Clopidogrel 300-600mg On NSS with extension 36”
Heparin 80-100unit/kg IV bolus and 3-ways
Shave both groins
Transfer to cath lab monitor with
external defibrillation ECG, Defib
Inform concent Transfer to cathlab

ก #' Defibrillator Defibrillator )( %*
( Defibrillator )
%*( external
pacing
IV which side ? ก cardiogenic shock

three way+ O2 canular,mask-->Intubation
extension 36 “ respirator
Hypotension
-IW-RV infarction :NSS loading
-LV infarction( ! HF) :Dopamine
Femoral artery occlusion

3
5/27/2011
Intervention
" # * HN, BW, Height, Payment

BW Heparin,Integrilin
Height IABP
Payment stent
Medication )+ ! ( , ก! ก % -". )
intervention
$ ! %& Biplane
Single plane
4
5/27/2011
!" # ก ). CAG
Thromboaspiration clot
Revasculalization During intervention

VT AIVR Medication Integrilin,Inotrope
www.psuheartcenter.com www.
psuhe
5
5/27/2011
During intervention
Intra Aortic Balloon Pump : IABP
Temporary pacemaker
Fast track
Post intervention
Post intervention Post intervention

Admit CCU,ICU Monitor ECG 24hrs ;' ^) Z : ก : Z 30 7Z 7 N/V ! a NPO
Hospitalization 2-3 days for uncomplicated case Z 7complication !8 ^) $ [ 2 '& 12 :8
Vital sign 15minx4,30minx2,1hrx2 Observe bleeding, a 78 ) 7 &
Bed rest : M Z ก' 30 9 $ [ 4 :8 ก off Bleed D sheath upsize sheath
sheath valve leakage change same size
Off sheath bleed pulse ! &) skin nick ก Z ; $ :
Observe chest pain ก ; pulse 78 E )Z Z
7ก 78 Valsalva ก $
E ก:
6
5/27/2011
Post intervention ก ) & + ! ). PCI

Bed rest 6hrs after sheath removal Stretching Pain " # : ) PCI l $ 78 ก7 M
eMM $ &7 Intermittent cath a " # ; 7 ก ;L &m ' [ กZ ; กก 78a Z
m a " :a ! coronary ก : ก ;$E D Z
Record I/O Z 1-2 :8
NSS 1cc/kg/hr at least 12 hr Acute Stent Thrombosis ก ;L ก กam^
F/U BUN,Cr >36-48hr 78M M: CIN 8! D ! ก ;L ก 78 '8 ก' am^ ;& M M:
;$ ก' 7n $ &: l7 : am^ ! ECG :ก M7
IABP , TP a ST กam^ ! 7 T wave 78 78 ; ก ' ก [7 7^" #
;$& ก ) ก : Z l7 M7 7กE :^ $ ) ก a ! p^)
7ก &: am^ M ! 78 ) PCI
!" # ก Off Sheath

/ ก 0 OFF sheath
Complication
Femoral artery Radial artery

7
5/27/2011
complication complication
complication complication
ก ก ก Balloon
Balloon
> +? ' &@ ( , ก B>') > DE .-. + B & 0
ก ก ก
Balloon
0.12 % 0.30 % 1.50 %
Balloon
&' ( 0.0006 % 0.00 % 0.00 % 0.12 % 0.30 % 1.50 % 0.49 %
* + ' 0.30 % 0.60 % 2.50 % &' ( 0.0006 % 0.00 % 0.00 % &' ( 0.12 %
* 0.30 % 0.60 % 2.50 % * 0.74 %
,-.ก/0 / ,- 0.10 % 0.10 % 0.50 % + ' + '
,-.ก/0 / 0.10 % 0.10 % 0.50 % ,-.ก/0 / 0.00 %
* 2& ก3 + 1.60 % 1.50 % 7.50 % ,- ,-
* 2& ก3 1.60 % 1.50 % 7.50 % * 2& ก3 1.48 %
+ +
0.00 % 0.30 % 0.50 % 0.00 % 0.30 % 0.50 %
Vasovagal 2.10 % 0.70 % 2.00 % ( ,I ?J 2553)
2553)
Vasovagal 2.10 % 0.70 % 2.00 %
(. 1 ( %& ??? ). 23 #!
1ก ". Antiplatelet Therapy in the Patient with Coronary Stent Undergoing Surgery and Dental
Procedure.
Noppadol Chamnarnphol
%* )). * ! 1 $# 0) 1 Division of Cardiology, Department of Internal Medicine, Faculty of Medicine,

Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
Songkla Med J Vol. 29 No. 2 Mar-Apr 2011
+ 23 E M78
Peripheral, plastic, and general surgery, elective surgery
/ biopsies; minor orthopaedic, ENT, and general ก ก " &: 78Z M Z
surgery; endoscopy; eye anterior chamber; MZ ' $ E ' ก
ก'
ASA (" +
dental extraction and surgery. & !8
ก กก. ! ก Transfusion seldom required
4$! ! 50
www. www.
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8
5/27/2011
). 23 #! Medication
E M78 ก ยาเม็ดสําหรับเคี้ยว ใหเคี้ยวยากอนกลืน (มิใชกลืนทันที) หรือใหละลายน้ําหรือของเหลวกอนกลืน
หรือสามารถใหรับประทานไดทั้งเม็ดโดยไมกลืนก็ได (แตยาชนิดนี้จะถูกดูดซึมเขาสูเสนเลือดไดเร็วถามี
Visceral surgery; cardiovascular surgery; elective surgery การละลายหรือเคี้ยวกอนใหยา) เพราะการเคี้ยวชวยลดขนาดอนุภาคยา (particle size) ไปบางแลว
major orthopaedic, ENT, ก ก " &: Z78 M Z เหมาะสําหรับความตองการฤทธิ์ Anti-platelet ใหเร็วขึ้น
By…ภก.สุฟยาน ลาเตะ เภสัชกรชํานาญการ โรงพยาบาลยะหริ่ง
reconstructive surgery; MZ ' $
Transfusions often required E ' ก & !8
endoscopic urology
E M78 M
Possible bleeding in a closed space; elective surgery
intracranial neurosurgery; ก ก " &: Z78 M Z
spinal canal surgery; MZ ' $ E ' ก
eye posterior chamber surgery ;' [ tirofiban/eptifibatide
Dual antiplatlet < 1year
heparin www.psuheartcenter.com
ก ". !ก ก กก. ! ก
4-6 weeks 8-12 weeks
' )!" ! # ก! ' กก. ! ก +? 'ก /
ก กก. ! ก ก ' & ' 6 !"

"(/ # $7ก (/ # ). # " 8 "! ก ' ). ก'&ก
# 6 # )!" ! !" 1 (ก ( + ก ( !" ก ' + '
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& ก !" ก ' + ' ). ก'&ก # 6 )+ # ก1 ก ' "! + %*ก ก
ก. ! ก -7 ก ' กก. ! ก )1ก# (/ # ' ( ) ก 6
#ก+ ( & ก ' ( # /9 + $. ! ) ก % '
$ ! ' + ) + %*ก ' & '
) http://www.fwdder.com
9
5/27/2011
www.themegallery.com LOGO
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5/27/2011

Nursing Care for Coronary

Heartburn or chest pain Heartburn or chest pain

ECG Guideline STEMI

Reperfused Non Reperfused

Then how to do ? Initial nursing care

Medication !" # ก # ก $ ! %&ER .

Inform concent Transfer to cathlab

IV which side ? ก cardiogenic shock

Femoral artery occlusion

" # * HN, BW, Height, Payment

Revasculalization During intervention

Post intervention Post intervention

Post intervention ก ) & + ! ). PCI

!" # ก Off Sheath

Femoral artery Radial artery

%* )). * ! 1 $# 0) 1 Division of Cardiology, Department of Internal Medicine, Faculty of Medicine,

4-6 weeks 8-12 weeks

' )!" ! # ก! ' กก. ! ก +? 'ก /

ก กก. ! ก ก ' & ' 6 !"

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